Our proposed model

We are proposing that we create a network of midwifery care services, including Midwife-led Units (MLUs) where women can give birth; new maternity hubs open 12 hours a day, seven days a week offering an enhanced range of services; clinics in the local community; home visits; and 24/7 access to midwives on the phone, by video or face to face.

The new model of care will include:

24 hour access to midwives by telephone, video link or face-to-face

Women will continue to be able to contact midwives any time of the day or night by telephone. As now, a midwife will be able to provide advice over the phone or may advise the woman to see a midwife in person. This could be at one of the MLUs at the RSH or PRH or the Consultant Unit. Under our new model, in future, midwives will also have access to video link so women could have a face-to-face conversation with midwives by using a mobile device or computer.
Clinics in local communities and home visits

Routine antenatal and postnatal clinics and appointments with midwives would continue to take place in community locations across Shropshire, Telford and Wrekin, including GP practices and children’s centres, as well as in women’s homes.
New maternity Hubs

Maternity hubs would be open 12 hours a day, 7 days a week. They would offer a range of services such as care from a midwife or maternity support worker, planned appointments with an obstetrician, scans to check a baby's development, mental health services and healthy lifestyle services. The opening hours of each hub and how often each service would be available could adapt depending on the needs of women in each community. Women and their partners will be able to meet other families at the hubs to share experiences and build support networks and stay for as long as they need during opening hours to get extra support. Each of the maternity hubs would provide outreach into communities where there is a need.
Birth options
Women would continue to be able to give birth in a full range of places
- Home birth
- Freestanding MLU
- Alongside MLU
- Consultant Unit

Home births

Women would continue to be able to give birth at home should they wish, provided they haven't agreed with their consultant or midwife that they need a higher level of care available at the Consultant Unit. Home births have the same level of care and back-up as a Freestanding MLU. Women requiring a higher level of care during labour are transferred to the Consultant Unit by ambulance.

Freestanding MLU (*currently at the RSH)

Women would continue to be able to give birth, 24 hours a day, 7 days a week, at the Freestanding MLU provided they haven't agreed with their consultant or midwife that they need a higher level of care at the Consultant Unit. This is suitable for women with uncomplicated pregnancies who wish to give birth in a non-medical environment. Births at a Freestanding MLU have the same level of care and back-up available as a home birth. They don’t have consultant care on the same site and women are transferred by ambulance to the Consultant Unit should they need a higher level of care during labour.

*This consultation does not affect the planned changes to women and children's services that were agreed by the CCGs in January 2019 after the Future Fit consultation to improve local acute hospital services. Those changes were to:

Move the women and Children's Consultant Unit from the PRH to the RSH to be on the same site as the Emergency Department when the hospital becomes an Emergency Care site.
Keep the two 24 hours a day, 7 days a week MLUs, one at RSH and one at PRH, where women can give birth and receive care during pregnancy (antenatal) and following birth (postnatal). Under these changes, the MLU at the RSH will be on the same site as the Consultant Unit so will become the Alongside MLU and the MLU at the PRH will become the Freestanding MLU.

Alongside MLU at the PRH (*currently at PRH)

Women would continue to be able to give birth at the Alongside MLU, 24 hours a day, 7 days a week,provided they haven't agreed with their consultant or midwife that they need a higher level of care at the Consultant Unit. Alongside MLUs are suitable for women with uncomplicated pregnancies who wish to give birth in a non-medical environment but have access to consultant care on the same site if needed.

Move the women and Children's Consultant Unit from the PRH to the RSH to be on the same site as the Emergency Department when the hospital becomes an Emergency Care site.

Keep the two 24 hours a day, 7 days a week MLUs, one at RSH and one at PRH, where women can give birth and receive care during pregnancy (antenatal) and following birth (postnatal). Under these changes, the MLU at the RSH will be on the same site as the Consultant Unit so will become the Alongside MLU and the MLU at the PRH will become the Freestanding MLU

Consultant Unit (*currently at PRH)

Women would continue to be able to give birth, 24 hours a day, 7 days a week, at the Consultant Unit. A Consultant Unit is staffed by a team including midwives, maternity support workers, obstetricians, anaesthetists (see glossary) and support staff. Care for women giving birth is often provided by midwives but doctors are involved if needed. Women and their babies who are at higher risk will be advised to give birth at the Consultant Unit.

Move the women and Children's Consultant Unit from the PRH to the RSH to be on the same site as the Emergency Department when the hospital becomes an Emergency Care site.

Keep the two 24 hours a day, 7 days a week MLUs, one at RSH and one at PRH, where women can give birth and receive care during pregnancy (antenatal) and following birth (postnatal). Under these changes, the MLU at the RSH will be on the same site as the Consultant Unit so will become the Alongside MLU and the MLU at the PRH will become the Freestanding MLU

Postnatal care

After their baby is born, women would receive the postnatal care they need closer to home, through their midwife or maternity support worker visiting them at home or by attending a clinic in their local community. They would also be able to get a range of postnatal care, advice and support at their nearest maternity hub. Women giving birth in a MLU will be able to stay for up to 6 hours before returning home unless they or their baby need extra care available at the Consultant Unit. Midwives would support women during their pregnancy to plan and prepare for leaving hospital after their baby is born. Women returning home would be able to contact midwives any time of the day or night for advise or support or visit their nearest maternity hub and stay for as long as they like during opening hours.

Continuity of carer

All women giving birth in a MLU or at home would receive all their care (including care in labour) from the same team of midwives. By 2021 we are aiming for this to be the case for the majority of women, wherever they give birth. This is in line with national recommendations included in Better Births and the NHS Long Term Plan (see glossary).